<div style='margin-bottom: 10px'> 
	<table cellpadding="0" cellspacing="0" class='inline' style='width: 870px;'>
	    <tr>
	        <th>{translate}Assigment details{/translate}</th>
	    </tr>
	    <tr>
	        <td style='padding: 10px 5px;'>
	        	<span class="label">{translate}Service group{/translate}</span>
	            <select name="radServiceGroup" id="radServiceGroup" style="width: 240px;">
	                <option value="0">- - {translate}Group{/translate} - -</option>
	                {html_options options=$groupList}
	            </select>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
	            <span class="label">{translate}Service{/translate}</span>
	            <select name="radService" id="radService" style="width: 240px;">
	                <option value="0">- - {translate}Service{/translate} - -</option>
	            </select>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
	            <input type="button" name="addRadServiceBtn" id="addRadServiceBtn" onclick="addRadService('radService', 'serviceListTbl');" value="{translate}Add{/translate}">
	        </td>
	    </tr>
	</table>     
	<div class="separator"></div>
	<table id="serviceListTbl" class="grid" cellpadding="0" cellspacing="0" style="width: 870px;">
	    <thead>
	         <tr>
	             <th>{translate}Service name{/translate}</th>
	             <th style="width: 80px;">{translate}Unit price{/translate}</th>
	             <th style="width: 80px;">{translate}Insurance payment{/translate}</th>
	             <th style="width: 80px;">{translate}Patient payment_1{/translate}</th>
	             <th style="width: 50px;">&nbsp;</th>
	         </tr>
	    </thead>
	    <tbody>
	        <tr id="total" class='last'>
	            <td><span style="color: red;">{translate}Total{/translate}</span></td>
	            <td><span style="color: red;" id="totalPrice">0</span></td>
	            <td><span style="color: red;" id="totalInsPrice">0</span></td>
	            <td><span style="color: red;" id="totalPatPrice">0</span></td>
	            <td>&nbsp;</td>
	        </tr>
	    </tbody>
	 </table>
</div>
<div>
	<span id="radAssignmentMsg" class="formAlertMsg" style="padding-left: 5px;"></span>
	<div id="createAssignmentLoaderDiv" style="display: none;">
	    <img src="{$base_uri}images/ajax-loader.gif">
	</div>
</div>